南加州洛杉磯西區中文學校

Chinese Language School of Southern California, West Los Angeles

Chinese Language Credit Application Form

School Year _____________________

Name of Student ____________________________ Chinese ________________________

Home Phone ________________________________ Family Number _________________

Chinese School Information

Language Class: _____________________________

Extra-curriculum Class: 1^st Semester _______________ 2nd Semester _______________

*If you have applied for Chinese Language Credit before, what was the name of the class

(e.g. Chinese A/B or Chinese I/II) _________________________________________________

High School Information

Name of School: ______________________________________________________________

Address: _____________________________________________________________________

School District: ‘ LAUSD ‘ Beverly Hills ‘ Santa Monica ‘ Culver City ‘ Other

Name of Counselor: ‘ Mr. ‘ Mrs. ‘ Ms. _____________________________________________

Counselor’s Phone Number: ( ) _____________________________________________

Important: You must receive a “C” or better in your academic work and also attend at least 108 hours (maximum 12 hours of absence) of lessons in order to be able to claim your 10 Chinese credits.

Remarks

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‘ $30 Processing Fee Paid ‘ High School Credit Application Form

* Please return this form to your CLSSC teacher or school office by October 10, 200X